Utilidad del registro EEG en el diagnóstico de encefalopatía asociada a ciclosporina A
Introduction. Cyclosporine A is one of the immunosuppressors most frequently used to prevent transplant rejection. Neurotoxicity is one of the complications often associated with it. These complications include acute encephalopathy, lethargy, confusion state, tremor, headache, motor disorders, visual changes and epileptic crises amongst others, even when blood levels are at what are considered to be ‘therapeutic’ levels. Clinical cases. We present the EEG anomalies found in 3 transplant patients (two liver transplants and on double lung transplant) to whom cyclosporin A had been given and who presented with status epilepticus. The EEG recordings showed paroxystic discharges of focal onset in the temporo-occipital areas. They were mainly correlated with the clinical findings of oculomotor and eyelid disorders. Conclusions. The topography of the neurophysiological findings supports –as do the other clinico-radiological findings– localization preferably to the posterior areas of cerebral dysfunction associated with cyclosporin A. Although the physiopathological origin of the encephalopathy of patients treated with cyclosporin A seems to correspond to multiple factors, we wish to point out the diagnostic usefulness of the identification of EEG changes localized to the temporo-occipital areas in the recognition of the neurotoxic syndrome in these patients
Casos clínicos Presentamos las anomalías EEG en 3 pacientes trasplantados (dos trasplantes hepáticos y uno bipulmonar) a los que se les administraba ciclosporina A y que presentaron estado de mal epiléptico. Los registros EEG críticos mostraron descargas paroxísticas de inicio focal en áreas temporoccipitales, que se correlacionaban principalmente con la presencia clínica de trastornos oculomotores y palpebrales.
Conclusiones La topografía de los hallazgos neurofisiológicos apoya –así como la de otros hallazgos clinicorradiológicos– una localización preferente en áreas posteriores de la disfunción cerebral asociada a ciclosporina A. Aunque el origen fisiopatológico de la encefalopatía en los pacientes tratados con ciclosporina A parece responder a factores múltiples, queremos señalar la utilidad diagnóstica de la identificación de alteraciones EEG localizadas en áreas temporoccipitales, para reconocer el síndrome neurotóxico en estos pacientes